Lyme other flu-like symptoms in stage one

Lyme disease is a vector
spread, gram negative spirochete (Borrelia
burgdorferi), which has become the most common tick-borne disease in the
United States. Expected clinical finding in a patient with Lyme disease are
broken into three temporal spaced stages. The first or early stage of the
disease is highlighted by erythema migrans (EM), a erythematous skin lesion which
expands with typical central clearing. Erythema migrans typically appears
within 10 days from a bite from an infected tick and resolves in 3-4 weeks.
Patients also classically experience malaise, myalgia, and head-aches or other
flu-like symptoms in stage one (Papadakis & McPhee,
2016). Progression of the disease into stage two is characterized by
continuation of flu-like symptoms as well as continued expansion of EM (Hu,
2017). Clinical distinction of stage two from stage one is seen with the
appearance of new skin lesions originating near initial bite location, but are
generally smaller in diameter. Manifestation of the disease into other body
systems can also be seen in stage two, with patients most commonly experiencing
facial neurological conditions, such as Bell’s palsy. If the disease remains
untreated, progression into stage three will occur anywhere from months to
years after initial infection. In this stage, expansion and further involvement
of alternate body systems continues with impact commonly on musculoskeletal and
neurologic systems. Up to 60% of untreated patients will experience
musculoskeletal complaints, most commonly articular arthritis (Papadakis &
McPhee, 2016).

            Diagnosis
of Lyme disease can simply be through clinical presentation although many times
the diagnosis is made in conjunction with serological testing as confirmation,
especially when the clinical picture is unclear. In patients with acute EM,
serological testing is not performed secondary to a decrease in sensitivity
resulting from prolonged time required for antibody production (Pagana, Pagana,
& Pagana, 2015). When warranted, lab testing for Lyme disease is usually
performed in a two-step process and routinely used to support the clinical
diagnosis (Hu, 2017).  Enzyme-linked immunosorbent assay (ELISA)
is the first serologic test performed, although it does show a high rate of
false positives. Positive test on ELISA would then permit further serological
testing through Western blot, or Immunoblot, testing (Papadakis & McPhee,
2016).

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            Immunoblot testing was developed from Southern
blot testing in the late 1970’s and is currently used as an IgG and IgM
antibody detection test in the diagnosis of Lyme disease. It is recommended
that serum for testing be taken from gold topped vacutainers although red topped
vacutainers could be used as well (Harrison, 2017). For a positive immunoblot
test for Lyme disease to occur, at least five of ten bands on the assay must be
positive for specific B. Burgdorferi
IgG antibodies as well as greater than two of the three bands sensitive to B. Burgdorgeri IgM antibodies (Pagana et
al., 2015). Immunoblot testing has a higher rate of sensitivity than ELISA
testing but higher rates of false negative results occur more frequently in the
beginning of presentation of the disease and thus retesting in following weeks
may be necessary (Hu, 2017).